Provider Demographics
NPI:1760400865
Name:OLIVER, MARQUAM R (MD)
Entity Type:Individual
Prefix:
First Name:MARQUAM
Middle Name:R
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:R
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1160 E 3900 S.
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-261-9651
Mailing Address - Fax:801-261-9656
Practice Address - Street 1:1160 E 3900 S.
Practice Address - Street 2:SUITE 1200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-261-9651
Practice Address - Fax:801-261-9651
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT183531-8905207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG11737Medicare UPIN